Extreme pain in the rectum. randomly appears. – digestive and bowel disorders forum – ehealthforum electricity names superheroes

##

The first time I noticed the symptoms i’m about to describe was when I was in the fourth grade. I am now 30. It is a very severe pain in the rectum/anus that sometimes only lasts for a few minutes. The longest it has ever lasted has been several hours. It usually brings the urge to deficate, though many times, I don’t even have to go. The pain is usually centered on one localized area (usually one side of the wall on the inside of my anus), though the area that it affects seems to be random.

Sometimes, the pain results in a non-sexual erection, and when I was younger, masturbation sometimes ended the pain. Since i’ve gotten older, masturbation sometimes (more often than not) makes it worse. The pain comes more often in the night, usually in my sleep. It is so severe, it will wake me up out of a dead sleep. It is also almost guaranteed to show up if I stay up for a very long time, or if I only get a few hours of sleep. About 75% of the time that I drink coffee or energy drinks, the pain comes back.

Sometimes, I will go a couple of months without ever feeling the pain. Other times, I will have the pain several times in one week. Sometimes, I can get rid of the pain by simply taking my mind off of it (read something that truly grabs my interest… Or think of anything at all that takes my mind away from the pain).

definition: proctalgia fugax refers to pain (sometimes severe) in the rectum. It can last from a few seconds to a few minutes and often occurs spontaneously during the night. Pain sometimes accompanies orgasm and there may be an urge to defecate. The pain is sharp and gripping but remains localized. Relief is spontaneous but some people find also relief from warm baths, or ice cubes (anything to disrupt the spasms). Medications, such as diazepam, may be prescribed in cases that are very regular and/or severe.

There is no known cause for the condition but it is not thought to be psychological in origin. There is no specific treatment, simply relief measures. Proctalgia fugux is associated more with people with irritable bowel syndrome and there may be some association with caffeine, artificial sweeteners or food additives.

My question is, is this something that i’ll have for the rest of my life, if indeed this is what I have? And the description above mentioned diazepam and/or other medications. I am not one to take medication… Ever. But this is so severe and so regular that i’m considering asking about it with my doctor. Does anyone have any more information on this disease/condition or the medications associated with easing the pain?

First described late last century but identified as a particular malady by T E Thansen in 1935, Proctalgia Fugax remains somewhat of an enigma today. Incurable and benign it is of consequence only to those who suffer its most acute symptoms.

Thansen, in describing it as ‘a fleeting pain in the rectum’ had obviously never suffered from the affliction. The pain, colloquially known as ‘anal cramp’, can persist for as long as an hour with some victims experiencing nausea and cold sweats – fainting attacks have been recorded. The cessation of pain brings a feeling of well-being akin to the removal of an abscessed tooth.

D M Nidorf and E R Jamison in the December, 1995 edition of the American Family Physician describe Proctalgia Fugax as ‘a fairly common but little known cause of rectal pain. It is a benign condition that has no known etiology’. They go on to say that ‘Several treatments have been tried and found anecdotally to be effective, although reassurance is the most useful therapeutic option’.

This latter observation is surprising given that the same authors describe the ailment as ‘Doctor’s Disease – the disease of the perfectionist male physician’. One would have expected at least one of the varied treatments tried by these suffering doctors to have been accepted as a standard remedy.

Research by Nidorf and Jamison using random sampling showed that about 15% of the population have experienced symptoms but few seek medical help due to its transitory and embarrassing nature. The embarrassment comes from attacks often being associated with orgasm. Gastroenterologist, W G Thompson, reported that of 2000 patients only 6 visited because of Proctalgia Frugax. Apparently men and women are equally affected. A H Douthwaite [British Medical Journal, July 1962] records that he had no spontaneous complaints from women but attributes that to women accepting it as a pain associated with the reproductive process and a normal part of life’s difficulties. In men the attacks are usually at night but in women day-time attacks are more prevalent.

Douthwaite records that coitus is not a provocative in females. However J A Mountfield [Canadian Medical Association Journal, 1986] in an article questioning the benign status of Proctalgia Fugax, reports a case of a woman who experienced attacks after every orgasm. His prescription of valium as a

Amyl nitrate, quinine, chloroform, phenobarbital, nifedipine, valium, ropantheline, oral clonidine and diltiazem have been tried without wide acceptance. Self anal-dilation has been used successfully by some doctors but is impracticable for most sufferers. Dr Eckert conducted a double-blind, cross-over trial in Germany [American Journal of Gastroenterology] with sixteen patients. He found that ‘two puffs of Salbutamol [.2 mg aerosol] shortened the duration of severe pain, particularly in patients having prolonged attacks’ but cautions that his trial group was small and more research is needed.

I was 28 when I first sought help. At this time attacks were months apart and invariably followed orgasm. The diagnosis from my GP was a prostate problem which probably required surgery and I decided to suffer. It was correctly diagnosed 6 years later when attacks were more frequent. By this time I had developed quite severe haemorrhoids as my only remedy had been a minimal defacation after much straining.

Some 5 years later a fellow hotel guest disappeared before dawn and arrived back late for breakfast. It transpired that he had been stricken with Proctalgia Fugax and had driven to a doctor acquaintance to be administered a ‘cold water enema’. From that day my pain problem was solved. A bulb enema is more important than a toothbrush in my toilet bag. On being awakened with anal cramp I adjourn to the bathroom and toilet and can be asleep again within 15 minutes. Little or no faeces is passed so I can only assume the passage of water activates the cramped muscles. Relief is instantaneous and is accompanied by a small flow of urine. My haemorrhoid problem is now manageable and I have peace of mind at night. I recently met a man who had suffered similarly for 15 years and he has now successfully adopted the same practice.

If Proctalgia Fugax is as common and unreported as research suggests, it should not be difficult for any practitioner to build a small database of patients. Douthwaite built up his trial group of 21 male and 27 female sufferers by asking leading questions of all patients, irrespective of their other health problems.

Reassurance that the condition is benign and will cease at death or age seventy, whichever comes first, should surely be accompanied by a treatment which can or may alleviate the extremely painful symptoms. A cold water enema [100mls] or Salbutamol are treatments any GP can offer with some hope of success.

Since this was written I have trialled salbutamol [Ventinol] with mixed success. In mild attacks the pain gradually eased before disappearing 10-15 minutes later. With severe attacks the pain eased but returned. A second dose 10 minutes later was successful on some occasions but on others I resorted to my proven remedy, the cold water enema. In practice now if I awake to mild pain, I use the inhaler. If it is severe I use the enema and am back to sleep in 15 minutes.